Provider Demographics
NPI:1548339682
Name:VIRGINIA PATHOLOGY SVCS PC
Entity type:Organization
Organization Name:VIRGINIA PATHOLOGY SVCS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GREISS
Authorized Official - Last Name:ROUSHDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-256-2962
Mailing Address - Street 1:6121 LINCOLNIA RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312
Mailing Address - Country:US
Mailing Address - Phone:703-256-2962
Mailing Address - Fax:703-256-3608
Practice Address - Street 1:6121 LINCOLNIA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312
Practice Address - Country:US
Practice Address - Phone:703-256-2962
Practice Address - Fax:703-256-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033048207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
284543OtherANTHEM
DC6365OtherBCBS
VA6605435Medicaid
MDOR66MGOtherBC-BS
92412OtherNCPPO
9845919OtherCIGNA
284543OtherANTHEM
G02151V01Medicare ID - Type Unspecified